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Coumadin (warfarin) Disease Interactions

There are 8 disease interactions with Coumadin (warfarin):

Oral Anticoagulants (Includes Coumadin) ↔ Bleeding

Severe Potential Hazard, High plausibility

Applies to: Thrombocytopathy, Thrombocytopenia, Coagulation Defect, Infectious Endocarditis, Vitamin K Deficiency, Myeloproliferative Disorders, Bleeding, Esophageal Ulceration, Peptic Ulcer, Colonic Ulceration, Ulcerative Colitis, Aortic Aneurysm, Cerebral Aneurysm, Pericarditis, Threatened Abortion, Pre-eclampsia/Eclampsia, Vasculitis, Diverticulitis, Malnourished, Vitamin C Deficiency

In general, the use of oral anticoagulants is contraindicated in patients with active bleeding or a hemorrhagic diathesis or other significant risks for bleeding, including hemostatic and/or coagulation defects associated with hemophilia, hypoprothrombinemia, thrombocytopenia, thrombocytopathy, severe hepatic impairment, and myeloproliferative disorders such as leukemia or polycythemia vera. Additionally, oral anticoagulants are usually contraindicated in the presence of any active ulceration of the gastrointestinal, respiratory, or genitourinary tracts; cerebrovascular hemorrhage; aneurysms (cerebral, dissecting aortic); pericarditis and pericardial effusions; bacterial endocarditis; and eclampsia, preeclampsia, or threatened abortion. These patients may be at increased risk for uncontrollable hemorrhage or bleeding complications during therapy with oral anticoagulants. Other potential contraindications include diverticulitis, vasculitis, malnutrition, and vitamin C or vitamin K deficiency. The decision to administer anticoagulants must be based upon clinical judgment in which the risks are weighed against the benefits in each patient.

References

  1. Landefeld CS, Cook EF, Flatley M, Weisberg M, Goldman L "Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy." Am J Med 82 (1987): 703-13
  2. Levine MN, Hirsh J "Hemorrhagic complications of anticoagulant therapy." Semin Thromb Hemost 12 (1986): 39-57
  3. White RH, McKittrick T, Takakuwa J, Callahan C, McDonell M, Fihn S "Management and prognosis of life-threatening bleeding during warfarin therapy." Arch Intern Med 156 (1996): 1197-201
View all 13 references

Oral Anticoagulants (Includes Coumadin) ↔ Diabetes

Severe Potential Hazard, High plausibility

Applies to: Diabetes Mellitus

Therapy with oral anticoagulants should be administered cautiously in patients with severe diabetes because they may be at increased risk for hemorrhage. The INR should be monitored closely, and patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References

  1. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.

Oral Anticoagulants (Includes Coumadin) ↔ Hypertension

Severe Potential Hazard, High plausibility

Applies to: Hypertension, Pheochromocytoma

In general, the use of oral anticoagulants is contraindicated in patients with malignant or severe, uncontrolled hypertension. These patients may be at increased risk for cerebral hemorrhage. Therapy with oral anticoagulants should be administered cautiously in patients with moderate hypertension.

References

  1. Hylek EM, Singer DE "Risk factors for intracranial hemorrhage in outpatients taking warfarin." Ann Intern Med 120 (1994): 897-902
  2. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.

Oral Anticoagulants (Includes Coumadin) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Oral anticoagulants (coumarin and indandione derivatives) are primarily metabolized by the liver. Patients with hepatic impairment may have a heightened response to these agents due to decreased clearance of the drugs as well as defective hemostasis associated with impaired synthesis of clotting factors by the liver. Therapy with oral anticoagulants should be administered cautiously in patients with severe or moderate liver disease. The INR should be monitored closely, and patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools

References

  1. Landefeld CS, Cook EF, Flatley M, Weisberg M, Goldman L "Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy." Am J Med 82 (1987): 703-13
  2. Demirkan K, Stephens MA, Newman KP, Self TH "Response to warfarin and other oral anticoagulants: effects of disease states." South Med J 93 (2000): 448-54; quiz 455
  3. Shetty HG, Fennerty AG, Routledge PA "Clinical pharmacokinetic considerations in the control of oral anticoagulant therapy." Clin Pharmacokinet 16 (1989): 238-53
View all 5 references

Oral Anticoagulants (Includes Coumadin) ↔ Protein C Deficiency

Severe Potential Hazard, Moderate plausibility

Applies to: Protein C Deficiency

Tissue necrosis is a rare complication that develops during the initiation of oral anticoagulant therapy due to thrombotic occlusion of venules in the dermis and subcutaneous tissues. Hereditary, familial, or clinical deficiencies of protein C or its cofactor, protein S, may be associated with a hypercoagulable state and an increased risk of the complication. Therapy with oral anticoagulants should be administered cautiously in patients with known or suspected deficiency in protein C-mediated anticoagulant response. Concomitant administration with heparin for the first 5 to 7 days of oral anticoagulant therapy may minimize the risk. If tissue necrosis develops, oral anticoagulant therapy should be discontinued promptly and vitamin K or frozen plasma administered at once. Heparin should then be considered for anticoagulation.

References

  1. Locht H, Lindstrom FD "Severe skin necrosis following warfarin therapy in a patient with protein C deficiency." J Intern Med 233 (1993): 287-9
  2. Eby CS "Warfarin-induced skin necrosis." Hematol Oncol Clin North Am 7 (1993): 1291-300
  3. Cole MS, Minifee PK, Wolma FJ "Coumarin necrosis: a review of the literature." Surgery 103 (1988): 271-7
View all 14 references

Oral Anticoagulants (Includes Coumadin) ↔ Decreased Response

Moderate Potential Hazard, Moderate plausibility

Applies to: Fluid Retention, Nephrotic Syndrome, Hyperlipidemia, Hypothyroidism

Patients with edema, hereditary coumarin resistance, hyperlipidemia, hypothyroidism, or nephrotic syndrome may exhibit lower than expected hypoprothrombinemic response to oral anticoagulants. Thus, more frequent laboratory (PT/INR) monitoring and dosage adjustment of anticoagulant may be required based on changes in the patient's condition.

References

  1. Ganeval D, Fischer AM, Barre J, et al "Pharmacokinetics of warfarin in the nephrotic syndrome and effect on vitamin K-dependent clotting factors." Clin Nephrol 25 (1986): 75-80
  2. Rice AJ, McIntosh TJ, Fouts JR, et al "Decrease sensitivity to warfarin in patients with myxedema." Am J Med Sci 262 (1971): 211-5
  3. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
View all 6 references

Oral Anticoagulants (Includes Coumadin) ↔ Increased Response

Moderate Potential Hazard, Moderate plausibility

Applies to: Congestive Heart Failure, Collagen Vascular Disease, Diarrhea, Fever, Malabsorption Syndrome, Hyperthyroidism

Patients with a collagen vascular disease (e.g., systemic lupus erythematosus, rheumatoid arthritis, scleroderma), congestive heart failure (especially decompensated disease), severe or prolonged diarrhea, fever, hyperthyroidism, malabsorption, or steatorrhea may exhibit greater than expected hypoprothrombinemic response to oral anticoagulants. Thus, more frequent laboratory (PT/INR) monitoring and dosage adjustment of anticoagulant may be required based on changes in the patient's condition. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References

  1. "Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
  2. Vagenakis AG, Cote R, Miller ME, et al "Enhancement of warfarin-induced hypoprothrombinemia by thyrotoxicosis." Johns Hopkins Med J 131 (1972): 69-73
  3. Owens JC, Neely WB, Owen WR "Effect of sodium dextrothyroxine in patients receiving anticoagulants." N Engl J Med 266 (1962): 76-9
View all 10 references

Oral Anticoagulants (Includes Coumadin) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

There is no evidence that hypoprothrombinemic response to oral anticoagulants (coumarin and indandione derivatives) is altered in renal impairment due to decreased plasma protein binding, thus dosage adjustments are generally not necessary. However, patients with renal impairment may demonstrate platelet defects and may be at increased risk for bleeding. Therapy with oral anticoagulants should be administered cautiously in patients with severe or moderate renal dysfunction. The INR should be monitored closely, and patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References

  1. Landfeld CS, Goldman L "Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy." Am J Med 87 (1989): 144-52
  2. Bachmann K, Shapiro R, Mackiewicz J "Warfarin elimination and responsiveness in patients with renal dysfunction." J Clin Pharmacol 17 (1977): 292-9
  3. Yacobi A, Udall JA, Levy G "Serum protein binding as a determinant of warfarin body clearance and anticoagulant effect." Clin Pharmacol Ther 19 (1976): 552-8
View all 8 references

You should also know about...

Coumadin (warfarin) drug Interactions

There are 779 drug interactions with Coumadin (warfarin)

Coumadin (warfarin) alcohol/food Interactions

There are 5 alcohol/food interactions with Coumadin (warfarin)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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